Oliveira dos Santos Claudy, Zijlstra Jan G, Porte Robert J, Kampinga Greetje A, van Diepeningen Anne D, Sinha Bhanu, Bathoorn Erik
Department of Medical Microbiology (EB 80), University Medical Center Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands.
Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
BMC Infect Dis. 2016 Apr 14;16:148. doi: 10.1186/s12879-016-1477-3.
Trichosporon species are ubiquitously spread and known to be part of the normal human flora of the skin and gastrointestinal tract. Trichosporon spp. normally cause superficial infections. However, in the past decade Trichosporon spp. are emerging as opportunistic agents of invasive fungal infections, particularly in severely immunocompromised patients. Clinical isolates are usually sensitive to triazoles, but strains resistant to multiple triazoles have been reported.
We report a high-level pan-azole resistant Trichosporon dermatis isolate causing an invasive cholangitis in a patient after liver re-transplantation. This infection occurred despite of fluconazole and low dose amphotericin B prophylaxis, and treatment with combined liposomal amphotericin B and voriconazole failed.
This case and recent reports in literature show that not only bacteria are evolving towards pan-resistance, but also pathogenic yeasts. Prudent use of antifungals is important to withstand emerging antifungal resistance.
毛孢子菌属广泛分布，是人类皮肤和胃肠道正常菌群的一部分。毛孢子菌属通常引起浅表感染。然而，在过去十年中，毛孢子菌属正逐渐成为侵袭性真菌感染的机会致病菌，尤其是在严重免疫功能低下的患者中。临床分离株通常对三唑类药物敏感，但也有对多种三唑类耐药的菌株报道。
我们报告了1例对泛唑类高度耐药的皮肤毛孢子菌分离株，该分离株在患者肝再次移植后引起侵袭性胆管炎。尽管给予氟康唑和低剂量两性霉素B预防，仍发生了此次感染，联合应用脂质体两性霉素B和伏立康唑治疗失败。
该病例及近期文献报道表明，不仅细菌正朝着泛耐药性发展，致病性酵母菌亦是如此。谨慎使用抗真菌药物对于应对新出现的抗真菌耐药性很重要。
